NCJ Number
73650
Date Published
1975
Length
100 pages
Annotation
This subcommittee met to examine the efficiency and effectiveness of the Part B section of the medicare program which is about reimbursement for physician services.
Abstract
Testimony was given by representatives of the General Accounting Office (GAO), the Social Security Administration (SSA), and Blue Shield of Florida, regarding the delays primarily in the reimbursement for physician services in Florida. According to GAO, 6 percent of the Florida claims filed take more than 60 days to process. Moreover, GAO reports that in addition to the problems caused by the rapid expansion and high seasonal fluctuations in workload, Blue Shield of Florida has been plagued with a high personnel turnover rate. Blue Shield's submitted testimony discusses some of the significant general points raised during the hearing; responds briefly to the GAO assessment; and lists recommendations for improvements regarding the Part B program. These recommendations include a time limit of 15 months from the date of service for the filing of claims; a revised medicare handbook which covers the prepayment screening process; and an elimination of the annual Part B deductible, with the resulting increased cost to be partially offset by a change in the co-insurance factor to 75 percent-25 percent. The most important recommendation was that the Social Security Administration should reduce its role in carrier decisionmaking and rely on its capacity to test carrier performance by results. In addition, SSA and its contractors should develop a relationship which will enable the private sector to add its full capability to the administration of the medicare program. However, in response to the delayed processing, the Bureau of Health Insurance of the Department of Health, Education, and Welfare has shifted the administration of one quarter of the Part B coverage to a new carrier. Tabular data and letters from dissatisfied insurees are appended.